Pradhan Alyssa, Wyld Melanie, Wan Susan, Davis Rebecca, Jayasinghe Kushani, Wyburn Kate
Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Nephrology (Carlton). 2025 Jun;30(6):e70058. doi: 10.1111/nep.70058.
BKPyV-DNAemia occurs in up to 30% of kidney transplant recipients (KTRs), with graft-threatening BKPyV-nephropathy in up to 10%. Risk factors for BKPyV-DNAemia, BKPyV-nephropathy, and associated graft loss are incompletely described. We sought to determine the prevalence, risk factors for, and long-term impact of BKPyV-DNAemia.
A single-centre retrospective study of adult KTRs between 2010 and 2018. We used logistic regression to determine odds ratios (OR) of BKPyV-DNAemia, and survival analysis to assess the impact of BKPyV-DNAemia on graft and patient survival.
Of 522 patients, 100 (19%) developed BKPyV-DNAemia and 43 (8.2%) developed BKPyV-nephropathy, resulting in the loss of two grafts. Factors associated with the development of BKPyV-DNAemia were non-Caucasian ethnicity (OR 1.76, CI 0.98-3.16), pre-transplant diabetes (OR 2.06, CI 1.02-4.14) and HLA mismatch of 3/6 or 4/6 (OR 2.37, CI 1.06-5.56) and HLA mismatch of 5/6 and 6/6 (OR 2.53, CI 1.20-5.63). Additionally, a greater than 25 mg per day prednisolone dose following acute transplant and acute rejection in the first month post-transplant was associated with an increased risk of BKPyV-DNAemia (OR 3.06, CI 1.66-6.06 and OR 2.36, CI 1.16-4.75 respectively). Over a 10-year follow-up, the development of BKPyV-DNAemia and BKPyV-nephropathy was not associated with reduced graft or patient survival.
While BKPyV-DNAemia and BKPyV-nephropathy remain prevalent in KTR, there were low rates of associated graft loss and no demonstrable impact on long-term graft or patient survival.
BK 多瘤病毒血症（BKPyV-DNAemia）在高达 30%的肾移植受者（KTRs）中出现，高达 10%的患者会发生威胁移植物的 BK 多瘤病毒肾病（BKPyV-nephropathy）。BKPyV-DNAemia、BKPyV-nephropathy 以及相关移植物丢失的危险因素尚未完全阐明。我们试图确定 BKPyV-DNAemia 的患病率、危险因素及其长期影响。
对 2010 年至 2018 年期间的成年 KTRs 进行单中心回顾性研究。我们使用逻辑回归确定 BKPyV-DNAemia 的比值比（OR），并通过生存分析评估 BKPyV-DNAemia 对移植物和患者生存的影响。
在 522 例患者中，100 例（19%）发生了 BKPyV-DNAemia，43 例（8.2%）发生了 BKPyV-nephropathy，导致 2 例移植物丢失。与 BKPyV-DNAemia 发生相关的因素包括非白种人种族（OR 1.76，CI 0.98 - 3.16）、移植前糖尿病（OR 2.06，CI 1.02 - 4.14）以及 HLA 错配为 3/6 或 4/6（OR 2.37，CI 1.06 - 5.56）和 HLA 错配为 5/6 和 6/6（OR 2.53，CI 1.20 - 5.63）。此外，移植后第一个月急性移植和急性排斥反应后泼尼松龙剂量大于每日 25 mg 与 BKPyV-DNAemia 风险增加相关（分别为 OR 3.06，CI 1.66 - 6.06 和 OR 2.36，CI 1.16 - 4.75）。在 10 年的随访中，BKPyV-DNAemia 和 BKPyV-nephropathy 的发生与移植物或患者生存率降低无关。
虽然 BKPyV-DNAemia 和 BKPyV-nephropathy 在 KTR 中仍然普遍存在，但相关移植物丢失率较低，且对长期移植物或患者生存没有明显影响。
